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What influences perceptions about the concept of return on investment from healthcare quality improvement programmes? An institutional theory perspective 是什么影响了人们对医疗质量改进计划投资回报概念的看法?制度理论视角
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-12 DOI: 10.1108/ijhg-04-2024-0045
S'thembile Thusini, T. Soukup, Claire Henderson
PurposeThis paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.Design/methodology/approachIn their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.FindingsThe authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.Originality/valueThe authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.
本文旨在强调影响医疗质量改进(QI)计划投资回报(ROI)概念化的因素。在之前的工作中,作者发现 QI 投资回报的概念非常广泛,包括组织的众多内部和外部利益。在本文中,作者从制度理论的角度出发,建立了一个框架,概述了影响这种 QI-ROI 概念化的因素。该框架基于作者对 QI 投资回报率概念决定因素的系列研究综述。研究时间为 2020-2023 年,涉及全球多学科系统文献综述(68 篇)、定性访谈(16 篇)和德尔菲研究(23 篇)。定性研究和德尔菲研究以英国公共资助的精神医疗保健为基础。研究结果作者概述了影响精神卫生保健和类似组织中 QI 项目投资回报概念化的内部和外部机构力量框架。基于这些因素,作者提出了若干猜想。在此过程中,作者强调了围绕 QI-ROI 概念化的模糊性和不确定性。这就要求领导者在组织和医疗系统的各种货币和非货币利益之间取得平衡。这就解释了 QI-ROI 概念的广泛性。原创性/价值作者制定了一个框架,强调了支撑 QI-ROI 概念广泛、模糊和有时不确定性质的各种力量。他们提高了人们对开发或应用任何工具来评估 QI 计划资金效益时所面临的困境的认识。具体而言,这项工作强调了投资回报率方法作为质量改进背景下的主要工具所具有的局限性,以及需要一种更全面的工具。
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引用次数: 0
What influences perceptions about the concept of return on investment from healthcare quality improvement programmes? An institutional theory perspective 是什么影响了人们对医疗质量改进计划投资回报概念的看法?制度理论视角
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-12 DOI: 10.1108/ijhg-04-2024-0045
S'thembile Thusini, T. Soukup, Claire Henderson
PurposeThis paper aims to highlight the factors influencing the conceptualisation of return on investment (ROI) from healthcare quality improvement (QI) programmes.Design/methodology/approachIn their previous work, the authors found that the concept of ROI from QI is broad and includes numerous internal and external benefits for organisations. In this paper, the authors developed a framework outlining the factors that influence this conceptualisation of QI-ROI from an institutional theory perspective. The framework is based on the synthesis of their serial studies on the determinants of the concept of ROI from QI. The research was performed from 2020–2023 and involved a global multidisciplinary systematic literature review (N = 68), qualitative interviews (N = 16) and a Delphi study (N = 23). The qualitative and Delphi studies were based on the publicly-funded mental healthcare in UK. Participants included board members, clinical and service directors, as well as QI leaders.FindingsThe authors outline a framework of internal and external institutional forces that influence the conceptualisation of ROI from QI programmes in mental healthcare and similar organisations. Based on these factors, the authors state several conjectures. In doing this, the authors highlight the ambiguities and uncertainties surrounding QI-ROI conceptualisation. These challenge leaders to balance various monetary and non-monetary benefits for organisations and health systems. This explains the broadness of the QI-ROI concept.Originality/valueThe authors developed a framework highlighting the forces underpinning the broad, ambiguous and sometimes uncertain nature of the QI-ROI concept. They raise awareness about dilemmas to be confronted in developing or applying any tool to evaluate the value for money of QI programmes. Specifically, the work highlights the limitations of the ROI methodology as a primary tool in the QI context and the need for a more comprehensive tool.
本文旨在强调影响医疗质量改进(QI)项目投资回报(ROI)概念化的因素。在之前的工作中,作者发现 QI 投资回报的概念非常广泛,包括组织的众多内部和外部利益。在本文中,作者从制度理论的角度出发,建立了一个框架,概述了影响这种 QI-ROI 概念化的因素。该框架基于作者对 QI 投资回报率概念决定因素的系列研究综述。研究时间为 2020-2023 年,涉及全球多学科系统文献综述(68 篇)、定性访谈(16 篇)和德尔菲研究(23 篇)。定性研究和德尔菲研究以英国公共资助的精神医疗保健为基础。研究结果作者概述了影响精神卫生保健和类似组织中 QI 项目投资回报概念化的内部和外部机构力量框架。基于这些因素,作者提出了若干猜想。在此过程中,作者强调了围绕 QI-ROI 概念化的模糊性和不确定性。这些都对领导者平衡组织和医疗系统的各种货币和非货币利益提出了挑战。这就解释了 QI-ROI 概念的广泛性。原创性/价值作者制定了一个框架,强调了支撑 QI-ROI 概念广泛、模糊和有时不确定性质的各种力量。他们提高了人们对开发或应用任何工具来评估 QI 计划资金效益时所面临的困境的认识。具体来说,这项工作强调了投资回报率方法作为质量改进背景下的主要工具所具有的局限性,以及需要一种更全面的工具。
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引用次数: 0
Doctors only blame the patients: a systems analysis of polycystic ovarian syndrome (PCOS) 医生只指责患者:多囊卵巢综合征(PCOS)的系统分析
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-08 DOI: 10.1108/ijhg-05-2024-0059
D. Mathur
PurposeThis study is conducted to understand an emerging public health problem in the garb of polycystic ovarian syndrome (PCOS) that affects about 6–21% of women in reproductive age from a systems perspective.Design/methodology/approachThe research is conducted in two phases. In phase 1, 15 women suffering from PCOS were interviewed to generate a knowledge map using an interpretive phenomenological research approach. The emerging themes were divided into four categories, namely individual, familial, societal, organizational, medical and systemic. In phase 2, five workshops were conducted with six invited actors to generate a causal loop diagram (CLD) of PCOS. The Standards for Reporting Qualitative Research (SRQR) are used in this study.FindingsA CLD from an individual's perspective with implications on organizational, societal and system levels.Research limitations/implicationsAwareness of “lifestyle diseases” is increasing, and this research shall help future studies put PCOS in the larger psychosocial context. The geographical location of respondents can be a limitation, as the causal linkages could only be true for the research site.Practical implicationsThe CLD provides a comprehensive understanding of complex emerging phenomenon of PCOS.Social implicationsThe paper draws attention to factors such as frequently changing doctors, withdrawal from work, medication fatigue, inclination to adopt due to infertility, etc.Originality/valueThis is the first such paper laying out the causal relationships between factors at the individual levels and connecting them to societal, organizational and system levels. This mapping can be useful for policymakers and industry leaders to empathize with PCOS sufferers so that their working conditions can be managed better.
目的本研究旨在从系统的角度了解一个新出现的公共健康问题,即多囊卵巢综合症(PCOS),该疾病影响着约 6% 至 21% 的育龄妇女。在第 1 阶段,对 15 名患有多囊卵巢综合症的妇女进行了访谈,采用解释性现象学研究方法绘制知识地图。新出现的主题分为四类,即个人、家庭、社会、组织、医疗和系统。在第二阶段,与六位受邀参与者举行了五次研讨会,以生成 PCOS 的因果循环图 (CLD)。本研究采用了《定性研究报告标准》(SRQR)。研究结果从个人视角绘制的因果循环图(CLD)对组织、社会和系统层面都有影响。研究局限性/意义人们对 "生活方式病 "的认识正在不断提高,这项研究将有助于未来的研究将多囊卵巢综合症置于更大的社会心理背景中进行研究。受访者的地理位置可能是一个限制因素,因为因果联系可能只适用于研究地点。社会影响本文提请人们注意频繁更换医生、退出工作、药物疲劳、因不孕而倾向于领养等因素。原创性/价值这是第一篇此类论文,它阐述了个人层面各因素之间的因果关系,并将其与社会、组织和系统层面联系起来。该图谱有助于政策制定者和行业领导者对多囊卵巢综合症患者产生共鸣,从而更好地管理他们的工作条件。
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引用次数: 0
Exploring the quality of life of palliative care patients: empirical evidence from India 探索姑息关怀患者的生活质量:来自印度的经验证据
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-19 DOI: 10.1108/ijhg-02-2024-0020
S.S. Dulari, M. Dhanya, Indu Nair
PurposeThis research paper aims to study the achievement of the objectives set by the Government of Kerala through the Arogyakeralam Pain and Palliative Care project.Design/methodology/approachThe research paper delves into diverse facets of an individual’s well-being including medical, emotional, spiritual and social aspects, when confronted with an incurable and incapacitating disease through the intervention of the PPC project. This insightful study was conducted in the state of Kerala, India.FindingsThe analysis reveals that quality of life (QoL) is most influenced by spiritual, social and psychological factors. This paper raises pertinent questions about the effectiveness of PPC initiatives within the realm of medical care.Social implicationsThe thought, conception and preparation of the subject is on improving social health care by assessing the existing practices followed by the local governance. This, by far, would benefit millions by formulating appropriate policies for improving the QoL.Originality/valueThe Kerala model of health care has garnered global acclaim, standing shoulder to shoulder with the health systems of developed nations. Adopting “active total care” to address pain and allied indications, the Arogyakeralam palliative care program significantly enhances patients' QoL. The focus was to uplift the QoL of patients suffering from terminal illnesses post-pandemic.
本研究论文旨在研究喀拉拉邦政府通过 Arogyakeralam 疼痛与姑息治疗项目设定的目标的实现情况。设计/方法/途径本研究论文通过姑息治疗项目的干预,深入探讨了个人在面对无法治愈和丧失能力的疾病时,其福祉的各个方面,包括医疗、情感、精神和社会方面。研究结果分析表明,生活质量(QoL)受精神、社会和心理因素的影响最大。社会影响本课题的思想、构思和准备工作是通过评估地方政府的现行做法来改善社会医疗保健。原创性/价值喀拉拉邦的医疗保健模式赢得了全球赞誉,与发达国家的医疗保健系统并驾齐驱。Arogyakeralam 姑息关怀计划采用 "积极的全面关怀 "来解决疼痛和相关适应症,大大提高了患者的生活质量。重点是提高大流行后绝症患者的生活质量。
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引用次数: 0
The role of governance in mitigating an epidemic disease: evidence from HIV prevalence in 45 Sub-Saharan African countries, 1996–2019 治理在缓解流行病方面的作用:1996-2019 年 45 个撒哈拉以南非洲国家艾滋病毒感染率的证据
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-17 DOI: 10.1108/ijhg-10-2023-0099
Moonsoo Lee, Yunmin Nam
PurposeThis study proposed a theoretical framework to illustrate how governance can be instrumental in preventing the proliferation of HIV. It decomposed governance into six multidimensional facets and empirically examined their effects on HIV prevalence.Design/methodology/approachThe study utilized panel data from 45 sub-Saharan African countries from 1996 to 2019. HIV prevalence, the dependent variable, was estimated based on the number of adults aged 15–49 years infected with HIV, irrespective of the progression to AIDS symptoms. The independent variables included governance and its six dimensions: voice and accountability, political stability, government effectiveness, regulatory quality, rule of law, and control of corruption. The analysis incorporated the random and fixed effects models while controlling for economic development, economic inequality, foreign aid, sanitation, and population.FindingsThe findings revealed a significant association between good governance and lower HIV prevalence. Improved governance quality in sub-Saharan African countries has led to a reduction in HIV prevalence among adults. Specifically, governance dimensions, such as voice and accountability, political stability, rule of law, and control of corruption, contributed to reducing HIV prevalence. Conversely, government effectiveness and regulatory quality did not show significant impacts on HIV prevalence.Originality/valueThis study underscores the significant role of good governance in effectively curbing the spread of epidemic diseases, highlighting its importance in controlling HIV in sub-Saharan African countries.
目的 本研究提出了一个理论框架,以说明治理如何有助于防止艾滋病毒的扩散。研究将治理分解为六个多维方面,并从实证角度考察了它们对艾滋病毒感染率的影响。研究利用了 1996 年至 2019 年 45 个撒哈拉以南非洲国家的面板数据。艾滋病毒流行率是因变量,根据 15-49 岁感染艾滋病毒的成年人数量估算,而不论其是否发展为艾滋病症状。自变量包括治理及其六个方面:发言权和问责制、政治稳定性、政府效率、监管质量、法治和腐败控制。分析纳入了随机效应和固定效应模型,同时控制了经济发展、经济不平等、外国援助、卫生设施和人口。撒哈拉以南非洲国家治理质量的提高导致成人艾滋病毒感染率下降。具体来说,治理的各个方面,如发言权和问责制、政治稳定、法治和腐败控制,都有助于降低艾滋病毒感染率。本研究强调了善治在有效遏制流行病传播方面的重要作用,突出了善治在撒哈拉以南非洲国家控制艾滋病毒方面的重要性。
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引用次数: 0
Editorial: IJHG author guidelines and policies 编辑:IJHG 作者指南和政策
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-16 DOI: 10.1108/ijhg-06-2024-162
I. Ibragimova, H. Phagava
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引用次数: 0
Appraisal of policy measures at the beginning of a pandemic: Empirical evidence from the first four months and 12 months of the COVID-19 pandemic 评估大流行初期的政策措施:COVID-19 大流行头四个月和十二个月的经验证据
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-08 DOI: 10.1108/ijhg-05-2023-0053
Emile du Plessis
PurposeThe rapid spread of the COVID-19 pandemic upended societies across the world, with billions forced into lockdowns. As countries contemplated instating and rolling back lockdown measures, and considered the impact of pandemic fatigue on policy measures, and furthermore to prepare for the improved management of future pandemics, this study examines the effectiveness of policy measures in limiting the spread of infections and fatalities.Design/methodology/approachThe methodological approach in the study centres on a fixed effects panel regression analysis and employs the COVID-19 Government Response Stringency Index, which comprises eight containment measures and three health campaigns, with progressive degrees of stringency, in order to investigate the efficacy of government policies.FindingsFindings suggest that some government policies were effective at reducing implicit mortality rates, infection cases and fatalities during the first four months of the COVID-19 pandemic. Solid stringency measures to reduce mortality rates include public gathering restrictions on more than 100 attendees, and international travel limits for developed countries and islands. Fatalities can further be reduced through the closing of public transport, whereas infection cases also experience benefits from public information campaigns. Comparable results are observed in a robustness test across 12 months.Originality/valueSome non-pharmaceutical policies are shown to be more effective than others at reducing the spread of infections, fatalities and mortality rates, and support policymakers to manage future pandemics more effectively.
目的 COVID-19 大流行病的迅速蔓延颠覆了全球社会,数十亿人被迫封锁。由于各国都在考虑制定和撤销封锁措施,并考虑大流行疲劳症对政策措施的影响,此外,为了更好地管理未来的大流行病,本研究探讨了政策措施在限制感染传播和死亡人数方面的有效性。研究结果研究结果表明,在 COVID-19 大流行的前四个月中,一些政府政策有效地降低了隐性死亡率、感染病例和死亡人数。降低死亡率的严格措施包括限制超过 100 人参加的公共集会,以及发达国家和岛屿的国际旅行限制。关闭公共交通可进一步降低死亡率,而公共宣传活动也可使感染病例受益。在跨越 12 个月的稳健性测试中观察到了相似的结果。原创性/价值在减少感染传播、降低死亡人数和死亡率方面,一些非药物政策比其他政策更有效,有助于决策者更有效地管理未来的流行病。
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引用次数: 0
Did the increase in birth grants result in higher births? Evidence from the Czech demographic and population policy change 生育补助金的增加是否导致了更高的出生率?捷克人口和人口政策变化的证据
IF 1.8 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-07-02 DOI: 10.1108/ijhg-04-2024-0036
Ondrˇej Dvouletý
PurposeThis research contributes to a better understanding of the effects of public demographic and population policy. The study investigates whether a considerable increase in birth grants in 2006 in the Czech Republic resulted in a higher number of births.Design/methodology/approachTo quantify the effects, we work with the administrative, statistical daily data (1993–2016) on the number of births and use time series analysis tools. In particular, we estimate a time series regression model via the ordinary least squares (OLS) technique with robust standard errors, testing placebo effects and the differences between the trend-forecasted values in the absence of the grant change.FindingsOur results, spread over several time windows covering up to a ten-year period after the intervention, show that the intervention significantly and positively affected the number of births in the post-intervention periods. The evidence obtained from the econometric analysis of the time series clearly shows that after the demographic and population policy change, there was an average increase of 17–19 births daily when the data was analysed up to 2016. Therefore, the conclusion is that the policy intervention led to expected and desired policy outcomes.Originality/valueThe study provides the stakeholders and policymakers with an experience of the public policy aiming to support fertility, which has reached its expectations.
目的本研究有助于更好地了解公共人口政策的效果。为了量化效果,我们使用了关于出生人数的每日行政统计数据(1993-2016 年),并使用了时间序列分析工具。特别是,我们通过普通最小二乘法(OLS)技术估算了一个时间序列回归模型,该模型具有稳健的标准误差,检验了安慰剂效应以及在没有补助金变化的情况下趋势预测值之间的差异。研究结果我们在干预后长达十年的几个时间窗口中得出的结果显示,干预对干预后时期的出生人数产生了显著的积极影响。对时间序列进行计量经济学分析所获得的证据清楚地表明,在人口和人口政策发生变化后,对截至 2016 年的数据进行分析时,平均每天的出生人数增加了 17-19 人。因此,结论是政策干预取得了预期和理想的政策成果。原创性/价值本研究为利益相关者和决策者提供了旨在支持生育的公共政策的经验,该政策已达到预期目标。
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引用次数: 0
Intersectional collaboration and the development of prevention infrastructures: a qualitative study 跨部门合作与预防基础设施的发展:定性研究
IF 1.3 Q3 Earth and Planetary Sciences Pub Date : 2024-06-14 DOI: 10.1108/ijhg-11-2023-0100
A. de Bekker, Païvi Reckman, Peter Kemper, Lidwien Lemmens
PurposeInvesting in prevention could be of great benefit to public health. Especially for people with health risks, such as overweight, depressive symptoms, low social-economic status or people who experience loneliness or a sedentary lifestyle. In the Netherlands, different parties are responsible for financing and organising selective and indicated preventive interventions: the government, municipalities and health insurance companies. The aim of this study was two-fold: First, to describe the transition towards a sustainable prevention infrastructure. And second, to gain insight into barriers and facilitators associated with intersectoral collaboration regarding organising prevention for high-risk groups.Design/methodology/approachA longitudinal qualitative study was conducted among collaborative networks working together to build a prevention infrastructure. During a five-year study period, 86 semi-structured interviews were held. The COM-B model was used for data analysis.FindingsBarriers to intersectoral collaboration are: unknown (cost-)effectiveness, limited incentives to invest in collaboration, lack of clarity about responsibilities, differences in priorities and organisational culture between municipalities and health insurers. Facilitators are commitment, trust, sharing knowledge between parties, meeting regularly within the network and acknowledgement of mutual responsibilities. Also, national policy interventions targeted at the development of regional prevention infrastructures facilitated collaboration.Originality/valueThis study shows that collaboration regarding prevention is becoming increasingly common. It can be concluded that the transition towards a sustainable prevention infrastructure has started. The relationship between key stakeholders, like municipalities and health insurers, is generally stronger than it was five years ago. They have a better understanding of each other’s interests and expectations.
目的 投资于预防工作对公众健康大有裨益。特别是对于那些有健康风险的人,如超重、抑郁症状、社会经济地位低下或孤独或久坐不动的人。在荷兰,政府、市政当局和医疗保险公司等不同方面负责资助和组织有选择性和针对性的预防干预措施。这项研究有两个目的:首先,描述向可持续预防基础设施过渡的情况。其次,深入了解与部门间合作有关的障碍和促进因素,以便为高危人群组织预防活动。设计/方法/途径 在合作网络中开展了一项纵向定性研究,以共同建设预防基础设施。在为期五年的研究期间,共进行了 86 次半结构式访谈。研究结果部门间合作的障碍是:(成本)效益不明、对合作投资的激励有限、责任不明确、优先事项不同以及市政当局和医疗保险公司之间的组织文化差异。促进因素包括承诺、信任、各方之间的知识共享、网络内的定期会议以及对共同责任的认可。此外,以发展地区预防基础设施为目标的国家政策干预也促进了合作。可以断定,向可持续预防基础设施的过渡已经开始。与五年前相比,市政当局和医疗保险公司等主要利益相关者之间的关系普遍加强。他们对彼此的利益和期望有了更好的理解。
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引用次数: 0
A self-assessment guide for readiness to govern 治理准备情况自我评估指南
IF 1.3 Q3 Earth and Planetary Sciences Pub Date : 2024-06-12 DOI: 10.1108/ijhg-04-2024-0035
Alex Berland
PurposeThis viewpoint introduces a “Readiness Self-Assessment Guide” that can be used as a diagnostic tool to help health service governors and managers, particularly in Low-Middle Income Countries, or those in the early stages of developing their governance program.Design/methodology/approachThe approach uses the conceptual framework for governance developed by Barbazza and Tello (2014).FindingsThe Guide is based on five foundational elements or components of governance that frame the actual governance activities. The self-assessment process uses a sequence of real-world examples to help users of the Guide assess their organization’s “readiness” or current capacity to strengthen quality. A simple scoring process allows users to rate their organization’s progress through potential evolutionary steps. The resulting analysis is intended to be the starting point of a structured discussion among team members about priorities, enabling factors and constraints.Practical implicationsAssessment of the institutional context is a fundamental step that will enable quality teams to select the appropriate tools for their priority concerns. This Readiness Self-Assessment Guide can be used as part of that diagnostic assessment.Originality/valueThis paper is empirically derived from the author’s experience as a consultant helping health service organizations and governing authorities to develop health governance programs in several countries.
本观点介绍了 "准备就绪自我评估指南",该指南可作为诊断工具,帮助医疗服务治理者和管理者,尤其是中低收入国家的治理者和管理者,或那些处于制定治理计划早期阶段的治理者和管理者。自我评估过程使用了一系列真实案例,帮助《指南》用户评估其组织在加强质量方面的 "准备程度 "或当前能力。通过简单的评分程序,用户可以对其组织在可能的演进步骤中取得的进展进行评分。对机构背景的评估是一个基本步骤,可帮助质量小组选择适当的工具来解决其优先关注的问题。本《准备就绪自我评估指南》可作为诊断评估的一部分。原创性/价值本文是作者作为顾问帮助多个国家的卫生服务组织和管理机构制定卫生治理计划的经验总结。
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引用次数: 0
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International Journal of Health Governance
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